Macrolide resistance in Streptococcus pneumoniae limits the empiric use of macrolide therapy of community-acquired pneumonia in pediatric patients. Fischer et al reported decision aids to identify a child likely to have Mycoplasma pneumoniae for whom macrolide therapy is appropriate. The authors are from the University of Zurich, University Children's Hospital of Zurich and the Max Planck Institute for Human Development.
Patient: child with community-acquired pneumonia (CAP)
Goal: to restrict macrolide antibiotic to those with Mycoplasma pneumoniae or other susceptible organism
Analysis:
(1) prediction rule with score
(2) fast-and-frugal decision tree
Parameters:
(1) duration of fever in days
(2) age of the patient in years
Parameter
Finding
Points
duration of fever
< 1 day
0
1 to 3 days
1
4 or 5 days
2
6 or 7 days
3
8 to 14 days
4
> 14 days
5
age
< 0.5 years
0
0.5 to 2 years
1
3 or 4 years
2
5 to 7 years
3
8 to 10 years
4
> 10 years
5
total score =
= SUM(points for the 2 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• Macrolide therapy can be used for a child who has high or very high risk for mycoplasma.
Score
Risk of Mycoplasma CAP
<= 3
low
4 or 5
moderate
6 or 7
high
>= 8
very high
Fast-and-Frugal Decision Tree
Duration of Fever
Age of Patient
Risk M. pneumoniae
<= 2 days
NA
low
> 2 days
<= 3 years
moderate
> 2 days
> 3 years
high
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